Gus Chan/The Plain DealerPresident Barack Obama continued his push for a change in the nation's health care in his appearance at Shaker Heights High School Thursday. He urged supporters to keep up efforts, even if the change is delayed until the fall.

President Barack Obama tried on Thursday to keep the nation's focus on reforming health care, using a town-hall-style rally at Shaker Heights High School to argue that America needs to act now to create a better and cheaper medical system.

"We have never been closer to achieving quality, affordable health care for all Americans," he said in what has become his stump speech this week on health care reform.

But the goal became a bit more complicated during his tripto Cleveland, where he hoped that the innovative medical institutions he named in his speech -- the Cleveland Clinic, University Hospitals of Cleveland and the MetroHealth System -- would help him make his case.

Back in Washington, however, congressional leaders largely gave up on passing health care reform before their summer recess, as the president had urged.

Obama acknowledged the news toward the end of his 23-minute remarks.

"You know, we just heard today that, well, we may not be able to get the bill out of the Senate by the end of August -- or the beginning of August," he said. "That's OK. I just want people to keep on working. Just keep working."

VIDEO: President Barack Obama's speech at the healthcare reform town-hall meeting at Shaker Heights High School.

Some members of both parties have balked at the potential cost of health reforms -- estimated to be at least $1 trillion over the next 10 years -- and at the administration's campaign-style push to pass reform quickly.

While Obama was in Cleveland, House Minority Leader John Boehner, a Republican from southwest Ohio, warned of higher health-care costs and even rationing if Obama and congressional Democrats pass sweeping reforms.

"I think we should scrap the plan and start over" with reforms that improve patient care while reducing costs, Boehner told reporters in a conference call.

He called the Democratic proposals on Capitol Hill a "$1.6 trillion monstrosity" and cited a recent Congressional Budget Office projection that one proposal being considered in the House would add $240 billion to the federal deficit.

Obama says he will reject any plan that adds to the deficit. But Obama and Boehner remain far apart on the reform issue.

The president fielded questions from the audience of about 1,600 packed into the sweltering Shaker High gymnasium with its flagging air-conditioning system. Removing his coat and rolling up his sleeves, he pointed to various people in the crowd to ask questions.

VIDEO: President Barack Obama answers questions from the audience during his town hall meeting on health-care reform at Shaker Heights High School.

But it was 14-year-old Shaker Heights freshman Parker Smith who captured the skepticism Obama faces here and in Washington.

"How can you reassure many Americans around the country that your health care proposal isn't too much, too fast?" Parker, dressed in a sport coat, asked politely.

"Well, I think that's a great question," Obama responded, moving toward him on the short stage.

Obama acknowledged that he had wanted a reform bill done by August but said he ultimately wants it ready by fall. He stressed that his ambitious reforms would not all take effect immediately.

"So it's not as if you're going to wake up tomorrow and suddenly the health-care system is all changed completely," he said. "We are going to phase this in, in an intelligent, deliberate way."

Obama found a friendly audience reminiscent of the true believers at his campaign rallies. But not all were ready to embrace his health reform plans.

Small-business ownerStuart Sharpe, who was not called on by the president, said he still worries about the potential costs.

"The primary discussion has focused on the uninsured, but the underlying problem is cost," Sharpe said before the speech. "What elements of the plan really address the cost of care?"

While the American Medical Association has endorsed Obama's reform plan, the Ohio State Medical Association has not. But that didn't stop the White House from allowing the association's president, Dr. Roy H. Thomas, to greet the president.

"He's a very likable guy," Thomas said.

But Thomas said that doesn't change the group's apprehension toward Obama's proposal to offer a public insurance program to compete with private insurers. Many critics fear that such a plan would give the government plan an unfair advantage and create another money-draining public health insurance program.

"We would rather see a health care consortium," Thomas said, referring to a plan that is not part of the current reform proposal but that Republicans have pushed.

The plan would call for private insurers to compete against each other -- much as they do now -- but with more regulation, including mandates to insure people with pre-existing conditions.

During the speech, Obama praised the Cleveland Clinic for how it pays its doctors and for its use of electronic medical records.

Clinic doctors receive a salary and are not paid by the procedure, something known as fee-for-service. Obama hopes more hospitals will copy that approach. But he acknowledged during his speech that not all hospitals will embrace the idea.

Clinic Chief Executive and President Toby Cosgrove, who met with Obama during a visit to the hospital before the Shaker Heights event, has not endorsed Obama's reforms but says government can still drive costs down and quality up.

Instead of paying physicians a fee for each procedure like a heart operation, they should be paid for whole episodes of care, Cosgrove said.

"That would begin to drive physicians into a collaborative system," said Cosgrove, who also was in the audience at the rally.

Still hoping to win congressional support, Obama, as he did during his 2008 campaign, asked the crowd for help.

"So, all right, everybody, stay on your members of Congress," he said. "Keep up the heat. We've got to get this done. Thank you. Love you. Bye."

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